{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARLA WORLEY","gend":1,"add":"42 LAUREL AVENUE","city":"DANVILLE","state":"VA","zip":"24541-5319","dob":"1979-05-18","age":"","mstatus":"","insh":10053605,"cliId":"","pno":4347138158,"cno":4347138158,"email":"","ename":"","eno":"","pphy":"ALLEYNE, LISA","ppno":5402483413,"pcpadd":"1371 LEE HIGHWAY, ","pcpcity":"VERONA","pcpstate":"VA","pcpzip":244820000,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":4342286332,"add2":"APARTMENT 1","add3":"","madd1":"42 LAUREL AVENUE","madd2":"APARTMENT 1","madd3":"","mcity":"DANVILLE","mstate":"VA","mzip":"24541-5319","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.31","M43.17","M54.5","M51.36","G43.809","R51","M62.81","R47.81","F15.10","R63.8","G89.29","I10","R29.810","Z86.69","Z86.59","Z98.890","Z90.710","Z88.0","Z88.2","J45.909","M19.90","M79.7","R56.9","Z91.81","Z91.048","M25.561","E78.5","E11.9","R79.89","N60.82","N64.89","F17.210","Z72.51","R93.1","R00.2","R06.02","R07.9","D37.09","F31.13","Z11.1","F39","J45.20","K63.5","Z11.4","K02.9","S63.92XA","M79.642","M25.532","X50.9XXA","M19.032","M77.9","B37.3","L02.215","S92.535A","S05.91XA","R10.9","Y04.8XXA","Z79.4","Z72.0","T07.XXXA","R58","R11.0","W19.XXXA","Z11.59","R73.9","Z88.1","Z88.8","Z85.9","S62.397A","S63.682A","Y04.0XXA","Z01.818","M54.42","Z79.899","M54.41","J18.9","A41.9","J96.01","J44.1","J15.9","R09.1","R07.89","E11.65","R06.9","R09.02","R06.00","R05","R20.2","Z82.0","R92.8","Z85.42","S60.211A","S90.32XA","W07.XXXA","Y92.009","Y99.9","L08.9","E66.9","T63.441A","M79.622","K08.89","Z12.31","K92.2","K62.89","Z86.010","K59.00","G40.909","Z68.36","F31.9","Z85.43","W24.0XXA","H53.149","D64.9","T38.0X5A","Z22.322","F14.10","F12.10","N20.0","N39.0","H92.03","R30.0","J45.31","R06.2","M79.605","M79.672","G40.89","F19.10","D10.30","F31.63","K04.7","J45.32","J45.901","W10.9XXA","R92.2","S01.81XA","W18.30XA","Y92.002","J45.41","G89.4","K13.70","S60.222A","Z53.20","K60.2","R10.13","Z48.00","A49.02","Z96.7","R93.7","J96.90","R41.82","W22.03XA","Y93.E6","H57.11","H53.8","R40.4","R40.2421","S21.002A","N60.32","E78.00","Z80.3","K21.9","F19.11","S62.367A","S63.602A","Z87.898","R53.1","R42","M51.9","Z98.1","R10.10","R10.11","B37.9","E11.649","L98.9","D75.1","M79.641","R73.01","L72.9","M79.675","M25.531","R11.2","R26.89","G62.9","R78.2","Z53.09","Z68.30","R29.6","Z79.84"],"date":["2021-04-14","2019-07-10","2021-03-02","2019-08-20","2019-04-27","2020-06-28","2019-04-27","2019-04-27","2019-04-27","2019-04-27","2020-06-23","2019-08-10","2019-04-27","2019-07-27","2019-04-27","2019-11-11","2020-09-11","2021-03-20","2021-03-20","2021-03-02","2020-06-24","2020-09-18","2020-07-13","2020-06-28","2020-09-11","2019-12-10","2021-02-22","2021-03-20","2020-08-26","2020-09-23","2020-09-23","2021-03-17","2020-11-23","2021-01-14","2021-02-22","2021-01-14","2021-01-14","2021-01-21","2021-04-02","2021-05-03","2020-06-23","2019-11-20","2019-11-11","2019-01-09","2019-01-10","2019-02-19","2021-03-20","2019-02-19","2019-02-19","2019-02-19","2019-04-15","2019-04-15","2019-05-23","2019-08-27","2020-05-05","2020-06-04","2020-05-05","2021-03-20","2020-06-28","2020-06-28","2020-06-28","2020-06-28","2020-07-02","2020-09-18","2020-08-11","2021-03-02","2021-03-20","2021-03-20","2021-03-17","2021-03-17","2021-03-17","2020-07-29","2019-08-20","2020-09-18","2019-08-20","2019-08-09","2019-08-09","2019-08-08","2019-11-11","2019-08-08","2019-08-08","2019-08-08","2020-08-24","2019-08-08","2020-07-13","2019-08-10","2020-02-25","2019-08-20","2019-08-20","2019-10-03","2020-09-18","2020-09-11","2020-03-15","2020-03-15","2020-08-15","2020-06-28","2020-05-29","2020-07-08","2020-08-15","2020-08-15","2019-03-21","2019-01-18","2019-02-07","2019-02-20","2019-02-20","2019-02-20","2020-06-24","2019-02-07","2021-02-22","2019-02-07","2019-02-19","2019-07-27","2019-08-08","2019-08-08","2019-08-08","2019-08-08","2019-08-08","2019-11-05","2020-07-13","2019-11-05","2019-11-05","2020-02-12","2020-09-11","2020-03-15","2020-03-15","2020-07-13","2020-07-13","2021-01-21","2019-02-25","2019-03-21","2020-02-12","2020-02-25","2020-03-10","2020-05-29","2020-06-28","2020-06-28","2020-06-28","2020-09-11","2020-09-11","2020-11-23","2021-03-20","2021-03-20","2019-01-31","2019-02-20","2019-05-23","2019-05-23","2019-07-10","2019-07-10","2019-08-10","2019-08-10","2019-08-27","2019-08-27","2020-05-05","2020-05-05","2020-07-13","2020-07-13","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2021-03-17","2021-03-17","2019-01-09","2019-04-27","2019-04-27","2019-07-30","2019-07-30","2020-06-04","2020-06-04","2020-07-02","2020-07-13","2020-09-23","2021-02-22","2021-03-17","2019-01-09","2019-05-21","2019-08-27","2020-03-10","2020-06-04","2020-06-23","2020-06-23","2020-07-08","2020-07-08","2020-07-08","2020-07-08","2020-07-08"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","67877022305","GABAPENTIN ","CAP 300MG","180","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","7","Select","Select",""],["","00054429731","FUROSEMIDE ","TAB 20MG","7","Select","Select",""],["","57237000830","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","00121057716","LACTULOSE ","SOL 10GM\/15","900","Select","Select",""],["","63402030430","LATUDA ","TAB 40MG","25","Select","Select",""],["","29300016915","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","53746010905","HYDROCO\/APAP ","TAB 5-325MG","5","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","68462031435","NYSTAT\/TRIAM ","CRE ","30","Select","Select",""],["","00093727298","PIOGLITAZONE ","TAB 30MG","30","Select","Select",""],["","66689000816","NYSTATIN ","SUS 100000","150","Select","Select",""],["","00597015330","JARDIANCE ","TAB 25MG","30","Select","Select",""],["","00591544310","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","00193709021","CONTOUR ","TES BLD GLUC","100","Select","Select",""],["","60432060416","PROMETHAZINE ","SYP DM","240","Select","Select",""],["","50111043303","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","23155010405","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","70377002811","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","68382001014","LAMOTRIGINE ","TAB 200MG","60","Select","Select",""],["","00591079401","DICYCLOMINE ","CAP 10MG","30","Select","Select",""],["","70000031801","MAG ","SOL LEMON","296","Select","Select",""],["","43386009019","GAVILYTE-G ","SOL ","4,000.00","Select","Select",""],["","69097084615","CYCLOBENZAPR ","TAB 10MG","20","Select","Select",""],["","13925015901","LIDOCAINE ","CRE 0.03","141.75","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","00093081101","NORTRIPTYLIN ","CAP 25MG","60","Select","Select",""],["","00143211205","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","69452017104","AZITHROMYCIN ","TAB 250MG","4","Select","Select",""],["","00173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","63304069201","CLINDAMYCIN ","CAP 150MG","30","Select","Select",""],["","60505311308","OLANZAPINE ","TAB 10MG","30","Select","Select",""],["","65862001905","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","64980017005","HYDROXYZ ","CAP 50MG","90","Select","Select",""],["","53885013610","ONETOUCH ","MIS LANCETS","100","Select","Select",""],["","53746046505","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","55111015905","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","69097084064","IPRATROPIUM\/ ","SOL ALBUTER","180","Select","Select",""],["","45802011222","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","55111068405","IBU ","TAB 800MG","30","Select","Select",""],["","00904198280","MAPAP ","TAB 325MG","100","Select","Select",""],["","45963043965","CONSTULOSE ","SOL 10GM\/15","946","Select","Select",""],["","55111028050","LEVOFLOXACIN ","TAB 500MG","10","Select","Select",""],["","60432027516","BROM\/PSE\/DM ","SYP ","200","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","00173085910","BREO ","INH 100-25","60","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}